Exploring the stability of communication network metrics in a dynamic nursing context

Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman et al., 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them "super stable." Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members' confidence in the information obtained from other staff members. When confidence was high, the "super stable" metrics remained "super stable," but when low, none of the "super stable" metrics persisted as "super stable." Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.National Institute of General Medical Sciences of the National Institutes of HealthOpen access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

“I want to know everything”: a qualitative study of perspectives from patients with chronic diseases on sharing health information during hospitalization

Abstract Background Patient-centered care promotes the inclusion of the most prominent and important member of the health care team, the patient, as an active participant in information exchange and decision making. Patient self-management of a chronic disease requires the patient to bridge the gap between multiple care settings and providers. Hospitalizations often disrupt established self-management routines. Access to medical information during hospitalization reflects patients’ rights to partner in their own care and has the potential to improve self-management as well as promote informed decision making during and after hospitalization. The objectives of this study were to elicit the perspectives of patients with chronic disease about desired medical information content and access during hospitalization. Methods This exploratory study incorporated a qualitative approach. The online survey included the research team created open and limited response survey, demographic and hospital characteristic questions, and the Patient Activation Measurement instrument (PAM®). Convenience and social media snowball sampling were used to recruit participants through patient support groups, email invitations, listservs, and blogs. The research team employed descriptive statistics and qualitative content analysis techniques. Results The study sample (n = 34) ranged in age from 20 to 76 (μ = 48; SD = 16.87), Caucasian (91%, n = 31), female (88%, n = 30) and very highly educated (64%, n = 22 were college graduates). The PAM® survey revealed a highly activated sample. Qualitative analysis of the open-ended question responses resulted in six themes: Caring for myself; I want to know everything; Include me during handoff and rounds; What I expect; You’re not listening; and Tracking my health information. Conclusions This study revealed that hospitalized patients want to be included in provider discussions, such as nursing bedside handoff and medical rounds. Only a few participants had smooth transitions from hospital to home. Participants expressed frustration with failures in communication among their providers during and after hospitalization and provider behaviors that interfered with patient provider communication processes. Patients also identified interest in maintaining their own health histories and information but most had to “cobble together” a myriad of methods to keep track of their evolving condition during hospitalization

Early warning systems and failure to rescue deteriorating patients

Failure to rescue (FTR) was initially coined as a metric to measure adverse events and outcomes in the post- surgical period. However, recent trends have shifted FTR away from its origin as a definitive outcome metric and instead place focus on the healthcare process factors that would lead to poor patient outcomes. While the inclusion of healthcare informatics, particularly Early Warning Systems (EWS), has targeted deteriorating patients as a priority, there remains much to be known about proper EWS implementation and the impact of human factors. Thus, the purpose of this study is to identify how EWS modulate barriers and facilitators of preventing failure to rescue. By performing a substantial literature review through CINAHL and PubMed databases, four key barriers and two key facilitators were found to impact rates of FTR. Interestingly, while many of these factors were rooted in human elements – communication, judgment, and fear – EWS provide useful routes for resolution of these issues. Ultimately, implementation of EWS can directly augment many of the vital characteristics of patient care, providing means for ease of communication, circumvention of interpersonal conflicts, and identification and treatment of the deteriorating patient. Through proper EWS implementation, frequency of FTR would decrease with patients experiencing reduced mortality and improved rates of successful interventions

Additional file 1: of “I want to know everything”: a qualitative study of perspectives from patients with chronic diseases on sharing health information during hospitalization

Benham-Hutchins Survey. Research team created survey questions. (PDF 293 kb

Defining and Scoping Participatory Health Informatics - An eDelphi Study

Background: Health care has evolved to support the involvement of individuals in decision making by, for example, using mobile apps and wearables that may help empower people to actively participate in their treatment and health monitoring. While the term „participatory health informatics“ (PHI) has emerged in literature to describe these activities, along with the use of social media for health purposes, the scope of the research field of PHI is not yet well defined. Objective: To propose a preliminary definition of PHI and define the scope of the field. Methods: We used an adapted Delphi study design to gain consensus from participants on a definition developed from a previous review of literature. From the literature we derived a set of attributes describing PHI as comprising 18 characteristics, 14 aims, and 4 relations. We invited researchers, health professionals, and health informaticians to score these characteristics and aims of PHI and their relations to other fields over three survey rounds. In the first round participants were able to offer additional attributes for voting. Results: The first round had 44 participants, with 28 participants participating in all three rounds. These 28 participants were gender-balanced and comprised participants from industry, academia, and health sectors from all continents. Consensus was reached on 16 characteristics, 9 aims, and 6 related fields. Discussion: The consensus reached on attributes of PHI describe PHI as a multidisciplinary field that uses information technologyand delivers tools with a focus on individual-centered care. It studies various effects of the use of such tools and technology. Its aims address the individuals in the role of patients, but also the health of a society as a whole. There are relationships to the fields of health informatics, digital health, medical informatics, and consumer health informatics. Conclusion: We have proposed a preliminary definition, aims, and relationships of PHI based on literature and expert consensus. These can begin to be used to support development of research priorities and outcomes measurements

Paging the Clinical Informatics Community: Respond STAT to Dobbs v Jackson's Women's Health Organization

If the coronavirus disease 2019 (COVID-19) pandemic was a wake-up call that clinical informatics and digital health play vital roles in our future, the 2022 U.S. Supreme Court ruling in Dobbs v. Jackson Women's Health Organization (Dobbs)[1] is a blaring alarm. Dobbs, which overturned Roe v Wade and Planned Parenthood v. Casey, allows states to individually regulate access to abortion. This ruling has triggered the enforcement of existing state laws that ban or restrict abortion and efforts to pass similar new laws